When the clinic opened in early June with Burris, her mentor Melissa Courtney, and two other midwives, it started the latest chapter in the long history of midwives in the Ohio Valley. Mary Breckenridge started American nurse midwifery in Hyden, Kentucky, with the foundation of Frontier Nursing Service. Now operating as Frontier Nursing University, it produces 30 percent of midwives in the country, including Burris.

Frontier nurses once famously slogged down creek beds on horseback to get to patients. Now, according to the American College of Nurse-Midwives (ACNM), 97 percent of midwives are affiliated with hospitals and most births take place in the hospital — not at home or in birthing centers.

Three nurse midwives on their horses in Leslie County, Ky., in 1931.

Credit University of Kentucky Archives

Statistics also show that across the country about 12 percent of vaginal births are delivered by midwives. According to the ACNM, that’s up about 20 percent between 2004 and 2014, the last year for which data are available.

Credit Alexandra Kanik | Ohio Valley ReSource

The history of midwifery in the region is strong. And today, Kentucky and Ohio have midwife programs in multiple affiliated hospitals. West Virginia also has a growing tradition of midwifery, with 19 percent of all vaginal births attended by midwives, a number higher than the national average of 12 percent.

Another factor pushing midwifery’s growth is that the service is covered by Medicaid. That government program provides medical care to the poor and pays for nearly half of the births in the country, according to the ACNM.

Over the years, the rate of pay of midwives through Medicaid has risen to match what Medicaid paid doctors for delivery: According to the ACNM, it’s a 100 percent match in Ohio and West Virginia and a 75 percent match in Kentucky.

Hippie Days

Still, when Emily Robertson, a school teacher, came to choose a midwife after researching on the internet, her husband needed a little convincing.

Jonathan Robertson, a mechanic, said he was worried about how safe his wife and child might be. But after learning more about how the process works, he got onboard.

Midwifery’s main attraction is its core focus on a healthy birth as a natural process. Over the years, Burris said, pregnancy became to be seen as something that always required medical treatment. Complex births do require medical assistance, she said. But most healthy births don’t.

Emily and Jonathan Robertson picked a midwife to attend the birth of their first child.

Credit Mary Meehan/Ohio Valley ReSource

Giving birth is one of the rare times people who are not sick are admitted to a hospital.

Jonathan Robertson said he found that approach convincing. “We look at it as something that is natural, we don’t look at as a medical problem,” he said.

Emily Robertson said she likes the personal attention and how supportive the midwives are. “When I call they listen to every little concern I have,” she said. “Even if it is a weird pain, they’ve been, ‘OK, this is normal,’ or, ‘this is not normal and you need to come in.’”

“When I started — I’m trying to think how I want to say it,” she said, searching for a diplomatic way to phrase things, “we had more of the hippy type moms, the vegetarians, those who wanted to do everything completely natural. Now it is very mainstream.”

She said midwives not only tend births but take care of many other women’s health needs before pregnancy and through menopause. And, yes, she said, even if a midwife delivers your baby, at delivery you can get an epidural.

Nurse Midwives JoAnne Burris and Melissa Courtney are two of the four nurses at the UK Midwife Clinic which opened in early June.

Credit UKHealthcare

A Calling

JoAnne Burris understands why women want more control of events during pregnancy.

“My first birth with my first child was natural birth, low intervention, but I felt very disempowered. Really it was fairly traumatic for me,” she said.

“With the second birth I wanted a different experience,” she said. She did some research and decided on Nurse Midwife Melissa Courtney for her second birth.

Courtney had opened an independent midwife clinic in 2011 and when Burris brought up hypnosis during childbirth, Courtney supported her decision.

But beyond that, Burris said, Courtney’s compassion and calm manner helped heal her trauma from her first birth.

She was so moved by the experience, she soon quit a 9 to 5 job in human resources, went back to school, and now has a hectic, unpredictable schedule delivery babies. She’s been a midwife for seven months.

“Do I get less sleep now?” Burris said. “Yes. Do I regret it? No.”

Burris called her career change a calling.

“I felt like I was being obedient to my higher power, who I call God, and I feel like that has been confirmed over and over again. I find myself having to blink back tears during a birth,” she said. “It’s so very much a privilege to hold space for a woman as she becomes a mother.”

And it’s a space more mothers-to-be seek as a traditional practice gets new life.

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By most measures, health outcomes in the Ohio Valley region are not very good, with many parts of Kentucky, Ohio, and West Virginia ranking near the bottom among states.

But a team of health researchers may have found a few places within the region that stand out. They see them as potential “bright spots” — places with some health measures better than expected for the region.

The University of Kentucky’s Center for Excellence in Rural Health is one of 38 organizations to receive funding from the Centers of Medicare and Medicaid Services. The $1 million grant will be used to help children in Appalachia get the health insurance they need, as well as provide to families that are eligible to coverage. Many Kentucky families are unaware they qualify for healthcare coverage so do not look into signing up for them or their children. This is especially difficult in rural parts of Eastern Kentucky, where healthcare providers have a hard time gaining access to those that need it most.